In the quest for youth—or at least a more youthful appearance—women and men are seeking treatments to minimize laugh lines, crow's feet, and frown lines, as well as to plump up lips and cheeks. A popular treatment involves injecting dermal fillers into the face. In studies of FDA-approved dermal fillers, people generally report they are satisfied with the outcome of their treatments.

They are highly satisfied with the ability of these medical devices to improve the appearance of wrinkles or facial features (e.g., lips or cheeks) and restore a youthful appearance.

But Food and Drug Administration (FDA) medical officer Janette Alexander, M.D., advises that it’s important to know the risks before having the treatment.

What are Dermal Fillers, and How are They Used?

Injectable dermal fillers are soft tissue and wrinkle fillers approved by FDA as medical devices. Generally, these products are injected into the skin to help fill in facial wrinkles, restoring a smoother appearance. In addition, fat taken from other body areas is often used with the same goals. Alexander says that most of the fillers achieve a smoothing or filling effect, which lasts for about six months or longer in most people.

FDA has approved only one permanent wrinkle filler, which contains the polymethylmethacrylate beads. These are tiny round, smooth, biocompatible plastic particles that are not absorbed by the body. The filler is FDA-approved only for correcting facial tissue around the mouth.

In addition, FDA has approved a number of injectable dermal fillers that are temporary because the body eventually absorbs them. These products are used for correcting soft tissue defects in the face, such as moderate to severe facial wrinkles and skin folds, lip and cheek augmentation, and to restore or correct the signs of facial fat loss in people with human immunodeficiency virus (HIV). Not all products have been approved for the indications mentioned above. Please refer to the FDA’s list of approved dermal fillers for more information on a specific dermal filler.

These temporary fillers include the following materials:

Collagen injections, made of highly purified cow or human collagen

Hyaluronic acid gel, a protective lubricating gel, produced naturally by the body

What are the Risks?

“As with any medical procedure, being injected with dermal fillers poses some risks,” Alexander says. “You should ask what you can expect and contact your health care professional if you are concerned about a particular side effect.”

The most common side effects include:

bruising

redness

swelling

pain

itching,

Additional side effects less commonly reported include:

infections

lumps and bumps

discoloration or change in pigmentation

Rare, but serious risks include:

scarring, blurred vision, partial vision loss, and blindness if the dermal filler is inadvertently injected into a blood vessel. It is recommended that health care providers take care to avoid injection into blood vessels (especially around the forehead, nose and eye area) for these reasons.

allergic reaction that may lead to a severe reaction (anaphylactic shock) that requires emergency medical help.

Most side effects occur shortly after injection and go away within two weeks, Alexander says. In some cases, side effects may emerge weeks, months, or years later. You should not use wrinkle fillers if you have:

severe allergies marked by a history of anaphylactic shock (the body’s potentially fatal allergic reaction)

What About Botox?

Botox Cosmetic and other botulinum toxin type A products such as Dysport and Xeomin are indicated for treatment of wrinkles. They are injectable drugs, but not dermal fillers. They work by keeping muscles from tightening so the wrinkles don’t show as much. FDA has approved these products only for the temporary improvement in the appearance of frown lines and crow’s feet.